An effective treatment for Alzheimer’s Disease might be on the horizon. But even with approval in the next 3 to 5 years, the healthcare system will likely be overwhelmed and patients may have to wait more than 18 months for diagnosis and care, according to a new report from the Rand Corporation.
“Our analysis shows the healthcare system is nowhere near prepared to deal with this,” said Soeren Mattke, a senior scientist with Rand and a report author. “We need a drug and infrastructure to deliver it.”
The biggest problem will be the lack of qualified providers to screen the 15 million middle-aged and older Americans with the earliest signs of brain health decline, Mattke’s report concludes. Approximately 5 million Americans currently have the slowly-fatal illness, which can last a decade or more, and which robs people of memories and functionality.
Dr. David Holtzman agrees that the number of neurologists is a limiting factor. “That is 100% correct and I think it’s going to be worse than they say here,” said Holtzman, president of the American Neurological Association, a trade group of neurologists, which has been warning about such a shortfall for years.
There are very few neurologists who see Alzheimer’s patients in clinic, Holtzman said, largely because the payment system doesn’t compensate doctors for the hour-plus it takes to diagnose and counsel patients with memory problems. The system will need to be changed before doctors will be able to dedicate the necessary time, he said.
Two years ago, the Alzheimer’s Association began a program to train more clinician-scientists to address this shortfall, said Heather Snyder, senior director of medical and scientific operations for the advocacy organization. “We’re trying to get ahead of it as far as we can.”
The Rand study assumes that there will be a successful treatment for Alzheimer’s within the next few years – which some say is wishful thinking and others believe is realistic.
There are more than 90 experimental Alzheimer’s treatments currently under development, with 15 “at least on pace to be on the market in the next five years,” said George Vradenburg, president and co-founder of the advocacy group UsAgainstAlzheimer’s.
Drug candidates in recent years have suffered one failure after another, “so I’m not going to bet my firstborn on this,” Vradenburg said. But he remains optimistic that at least one of the drugs under development will show some effectiveness against Alzheimer’s.
Pharmaceutical companies may have tested their drugs on patients who already had too much damage to benefit, Vradenburg and others said. Diagnosing patients at the earliest signs of disease should enable more effective treatments.
“I’m pretty convinced, you’re going to have to start before people are symptomatic or when they have a touch of a problem,” said Holtzman, who is also chair of Neurology at Washington University School of Medicine in St. Louis.
But finding disease that early won’t be easy.
Many of the treatments under development target the buildup of a protein called amyloid, which is characteristic of Alzheimer’s but not of other dementias, such as those caused by the vascular system, or Parkinson’s. Now, the only way to track amyloid in the living brain is with a PET scan, which is expensive, invasive, and unavailable to people living in large swaths of the country, the Rand study noted.
A method to detect Alzheimer’s through blood, saliva, urine, skin or the eyes – which are all being investigated - would allow general internists or nurse practitioners to raise a flag and shorten the treatment process, said Snyder of the Alzheimer’s Association. “We need that non-invasive, easy to deploy tool that can help identify who should go on to that further follow up.”
Vradenburg, of UsAgainstAlzheimer’s, said he is also concerned about how insurance companies will pay for any new treatments. Though they may be expensive, he said, the cost of treating an Alzheimer’s patient, many of whom require full-time nursing home care, justifies a relatively high-cost drug. “Society in the end will save a helluva lot of money, if we get an effective drug out there,” he said.
In the end, Holtzman said the infrastructure challenges are more likely to be resolved once a treatment becomes available.
“I think we need a hit in the field,” Holtzman said. “Once that happens…you can build on top of that.”